Not just a Wenckebach, not yet a complete heart block

Area of Science:

• Cardiology
• Infectious Diseases
• Electrocardiography

Background:

• ECG findings in aortic valve infective endocarditis are uncommon, usually presenting as AV dysfunction.
• This case involves a patient with Enterococcus faecalis bacteremia and an aortic root abscess.

Purpose of the Study:

• To present an unusual ECG presentation in a patient with infective endocarditis.
• To highlight the diagnostic importance of subtle ECG findings in septic patients.

Main Methods:

• Case report of an 80-year-old male with a bioprosthetic valve presenting with sepsis.
• ECG analysis revealed new onset Wenckebach physiology.
• Transesophageal echocardiography confirmed an aortic root abscess.

Main Results:

• The patient exhibited Wenckebach physiology with a consistent PP interval.
• ECG showed variations in QRS morphology, suggesting Gap phenomenon and phase 4 conduction block.
• Aortic root abscess was identified as the source of infection.

Conclusions:

• Subtle ECG findings like Wenckebach and Gap phenomenon can indicate serious underlying conditions such as aortic root abscess.
• Recognizing AV dysfunction on ECG is critical in managing septic patients.
• This case underscores the importance of detailed ECG interpretation in the context of bacteremia.